Canadian Dental Patients with a Single-Unit Implant-Supported Restoration in the Aesthetic Region of the Mouth: Qualitative and Quantitative Patient-Reported Outcome Measures (PROMs)

Minimally Invasive Laminate Veneer Therapy for Maxillary Central Incisors

Minimally invasive dentistry is a considered process that requires the clinician to be prepared with the ideal sequence and the tools needed. This report describes a well-planned ultraconservative approach using only two ceramic laminate veneers for the maxillary central incisors to significantly improve the patient's overall smile. A 30-year-old female presented with the chief complaints of having diastemas between the central and lateral incisors as well as incisal wear. Diagnostic wax-up and mock-up were performed, and the patient approved the minimally invasive treatment with veneers only for central incisors. A reduction guide aided the conservative tooth preparations, and hand-crafted feldspathic veneers were bonded under total isolation with a rubber dam. The two final conservative veneers significantly improved the smile and fulfilled the patient's expectations. Following proper planning and sequencing, predictable outcomes were obtained and fulfilled the patient's esthetic demands. Minimally invasive restorative dentistry with only two single veneers can impact the entire smile frame. Overtreatment in the esthetic zone is unnecessary to meet a patient's esthetic expectations.

FOR PERI-IMPLANT SOFT TISSUE AUGMENTATION, SOFT TISSUE SUBSTITUTES MAY IMPROVE PATIENTS' SURGICAL AND POSTOPERATIVE EXPERIENCE COMPARED TO AUTOGENOUS GRAFTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Thoma DS, Strauss FJ, Mancini L, Gasser TJW, Jung RE. Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures. Periodontol 2000. 2022 Aug 11. doi:10.1111/prd.12465. Online ahead of print. PMID: 35950734.

SOURCE OF FUNDING

Not reported.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Diagnostic Mock-Up as a Surgical Reduction Guide for Crown Lengthening: Technique Description and Case Report

Background and Objectives: The report describes a technique using a diagnostic mock-up as a crown-lengthening surgical guide to improve the gingival architecture. Materials and Methods: The patient's primary concern was improving her smile due to her "gummy smile" and short clinical crowns. After clinical evaluation, surgical crown lengthening accompanied by maxillary central full-coverage single-unit prostheses and lateral incisor veneers was recommended. The diagnostic mock-up was placed in the patient's maxillary anterior region and used as a soft tissue reduction guide for the gingivectomy. Once the planned gingival architecture was achieved, a flap was reflected to proceed with ostectomy in order to obtain an appropriate alveolar bone crest level using the overlay. After six months, all-ceramic crowns and porcelain veneers were provided as permanent restorations. Results: A diagnostic mock-up fabricated with a putty guide directly from the diagnostic wax-up can be an adequate surgical guide for crown-lengthening procedures. The diagnostic wax-up was used to fabricate the diagnostic mock-up. These results suggested that it can be used as a crown-lengthening surgical guide to modify the gingival architecture. Several advantages of the overlay used in the aesthetic complex case include: (1) providing a preview of potential restorative outcomes, (2) allowing for the appropriate positioning of gingival margins and the desired alveolar bone crest level for the crown-lengthening procedure, and (3) serving as a provisional restoration after surgery. Conclusions: The use of a diagnostic mock-up, which was based on a diagnostic wax-up, as the surgical guide resulted in successful crown lengthening and provisional restorations. Thus, a diagnostic overlay can be a viable option as a surgical guide for crown lengthening.

Conventional free-hand, dynamic navigation and static guided implant surgery produce similar short-term patient-reported outcome measures and experiences

Design A randomised controlled trial study comparing patient-reported outcome measures (PROMs) and experiences (PREs) using conventional brain-guided (free-hand), dynamic computer-assisted implant surgery (dCAIS) and static computer-assisted implant surgery (sCAIS) for dental implant placement.Case selection Ninety subjects who met the inclusion criteria (that is, at least 20 years of age interested in dental implant treatment) accepted to participate in the trial and were randomly allocated to three groups between August 2019 and October 2020, according to the dental implant placement protocol, by means of block randomisation. The included subjects were required to undertake several self-administered questionnaires concerning: 1) pre-operative expectations (that is, five items evaluating patients' perceptions using a 5-point Likert scale and six items about patients' expectations concerning the planned surgery); 2) post-operative healing complications or events during the immediate post-operative week (that is, pain intensity assessment on a continuous visual analogue scale [VAS] 0-10, oedema or swelling evaluation on four grades ranging from no oedema [Grade 1] to extraoral oedema reaching beyond the surgical zone [Grade 4] and analgesic drugs intake); and 3) post-operative PROMs at a two-week follow-up (six items evaluating the post-operative symptoms experience and eight items measuring overall patient satisfaction using a 5-point Likert scale).Data analysis Kolmogorov-Smirnov test determined a non-normal distribution. Consequently, Wilcoxon signed-rank test assessed the intra-group differences and Kruskal-Wallis test was applied for inter-group comparison using the Statistical Package for the Social Sciences (IBM SPSS version 24; Chicago, IL). Spearman's correlation test evaluated the relation of patients' or implant procedures' characteristics with the maximum mean pain score, analgesic intake and oedema grade. The significance level alpha was set to 0.05. Lastly, Cronbach's alpha was used to evaluate the internal consistency for perceptions (0.53), expectations (0.76) and satisfaction (0.85).Results Only two subjects were excluded for missing the two-week follow-up visit. Both subjects belonged to the dCAIS group. Hence, 88 participants (mean age = 57.7 years) corresponding to 179 implants placed were evaluated. Sex was the only subjects' characteristic with a significant difference as more women were included (60%; p = 0.020). Most of the subjects had one (38%) and two (45%) dental implants at anterior (11%) and posterior sites (80%) with full-thickness flap operation (95%) but without simultaneous guided bone regeneration (57%). In terms of the surgical duration, sCAIS took the longest (89.70 ± 45.75 min), followed by dCAIS (70.95 ± 42.48 min) and brain-guided protocol (70.30 ± 47.08 min). Nevertheless, there was no significant inter-group surgical time difference (p = 0.076). Concerning the pre-operative patients' perspectives on dental implant intervention, most participants believed that implants would permit chew (93%), sound (88%) and appearance (91%) to be as close as with natural dentition. Interestingly, 32% believed that osseointegrated implants require less maintenance than natural dentition and 73% stated that implants last a lifetime. There was a significant difference between the groups regarding the both the amount of time they expected to be in pain postoperatively (p=.035) and the amount of post operative swelling they expected (p=0.006)There was no significant inter-group difference in magnitude of post-operative pain, oedema and analgesic intake. The dCAIS group expected longer to adapt to speaking (p = 0.030). The inter-group analysis of expected chewing difficulties evidenced significant differences (p = 0.040). Regarding the PREs, significant inter-group differences were displayed in duration of post-operative pain (p = 0.010), phonetic limitations (p = 0.038) and impact on routine activities (p = 0.046). After one week, the conventional and the sCAIS groups still had the highest (1.40 ± 2.43) and lowest (0.77 ± 1.85) pain scores. Concerning the self-reported post-operative oedema grading, it peaked on day two and most participants referred intraoral oedema (Grade 2) to extraoral oedema (Grade 3). Again, no significant inter-group difference was detected in the six measured time points regarding pain, oedema or analgesic intake. The highest post-operative oedema at day two was significantly correlated with flap operation (p = 0.030). During the first post-operative week, there was a low mean analgesic intake (5.13 ± 5.52). The first post-operative day had the highest consumption of analgesic drugs and the highest group consumption was by the conventional group. The post-operative healing experience and functional limitations were considered acceptable by most participants. Oedema had the lowest acceptable proportion (59%), followed by oral hygiene care difficulty (64%) and chewing (65%). The only intra-group difference in patients' acceptance was evidenced in the post-operative speaking difficulties of the sCAIS group (p = 0.015). Ninety-two percent of participants were satisfied with the clinical service (median = 5.0) and 89% were satisfied with the overall implant surgery (median = 4.0).Conclusions Placing dental implants with conventional brain-guided, sCAIS or dCAIS protocols obtained a similar post-operative level of patient satisfaction, analgesic intake, oedema and pain. Patients reported the dental implant post-operative symptoms to be acceptable even though they expected a shorter inflammation duration. The highest level of pain and oedema were experienced six hours and two days post-operative, respectively, regardless of the surgical protocol.